医疗保险承受力的健康风险平滑效果评估——基于中低收入参保群体的研究  

The Effect of the Affordability of Health Insurance on Smoothing Health Risk—Evidence from Low-and Middle-Income Medical Insurance Participants

作　　者：贺梦阳 丁建定 HE Mengyang;DING Jianding(Huazhong University of Science and Technology,Wuhan,China)

机构地区：[1]华中科技大学社会学院,430070

出　　处：《经济学动态》2022年第4期83-102,共20页Economic Perspectives

基　　金：国家社会科学基金重大项目“西方社会保障制度史(多卷本)”(19ZDA234)。

摘　　要：“十四五”规划提出,要完善稳定公平的待遇保障机制与可持续的医疗保障筹资机制,提升医疗保障服务能力和服务水平,最大限度地降低参保群体的就医负担。疾病风险的不确定性、医疗支出的刚性需求等风险因素,使得中低收入参保群体仍有可能面临因病致贫或返贫的困境。本文从理论和实证两方面出发,基于中国家庭追踪调查(CFPS)数据,构建中低收入参保者压力准备金对医疗服务需求价格敏感性的面板门槛模型,以评估医疗保险承受力的划分标准,并在此基础上讨论参保行为与健康风险因素对医疗保险承受力的影响。研究结果表明,无论是中高收入参保群体还是中低收入参保群体,健康风险显著增加压力准备金支付压力,参保个体健康状态程度对医疗费用支出的边际效应均有显著影响;相较于中低收入者,中高收入者具有更强的即期抗疾病经济风险能力。进一步分析医疗保险和健康风险对中低收入参保群体医疗保险承受力的影响,本文发现健康风险显著增加了个体医疗支出成本,需要预留更多的压力准备金应对即期医疗支出,存在应对疾病经济风险的脆弱性。合理确定医疗保险承受力标准,降低就医成本,提升医疗服务利用可及性,探索防范与化解因病返贫致贫的偿付机制,是实现医疗保险群体受益公平的关键。The 14th Five-year Plan states that it is necessary to achieve both universal coverage of medical insurance and sustainable medical financing mechanism.Chances are low-and middle-income medical insurance participants fall into or return to poverty due to the uncertainty in illness and health risks from the rigid demand of medical costs.Based on the China Family Panel Studies Data(CFPS),this paper constructs a panel threshold model,exploring the standard of the affordability of health insurance expenditure according to the healthcare cost level of low-and middle income medical insurance participants.From the analysis of descriptive statistics,compared with low-and middleincome medical insurance participants,middle-and higher-income medical insurance participants are better able to cope with health risks.Finally,this study examines the effect of health status on the marginal effect of medical expenses.In order to realize the fairness of the benefits in health insurance system,the government should ensure the health insurance affordability.With the increased risk of poverty caused by illness,reducing the cost of medical utilities and improving the availability of medical services are keys to exploring the sustainable efficiency of reimbursement mechanism.

关 键 词：医疗保险承受力 中低收入群体 健康风险 疾病经济风险 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]